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Competency Framework for Mainstreaming Gender Responsive Health Care Services: Major Concerns

The Institute is conducting a two year project titled, "Developing competency framework for mainstreaming gender responsive health care services" supported by Indian Council of Medical Research (ICMR) with an objective to assess health care providers and managers understanding / perspective on gender equality and equity and thus to develop a competency framework for helping health care providers, both men and women to cater services receptive to gender. The formative phase of the study included review of roles and responsibilities of various health functionaries from the gender perspective. Then a matrix indicating the gender gaps in the roles, responsibilities and services of the health care providers was developed with the help of Delphi expert-team. Along with the matrix, indicators based on knowledge, attitude and practices of health care providers regarding adolescent reproductive and sexual health were also developed to assess their gender related competencies. Situational analysis was done for assessing the current situation of the healthcare services being provided. Data from six districts of Rajasthan (Ajmer, Banswara, Bharatpur, Jodhpur, Sri Ganganagar and Udaipur) was collected for developing competency framework. It is important to understand that only four ANMs/ GNMs had ever attended training on ARSH since NRHM was launched in 2005.

A vast majority of ANMs and GNMs felt that there should be government scheme for the benefit of adolescent boys as SABLA or other schemes have focused on adolescent girls only. In our context, girls are informed by their mothers and sisters/ sisters-in-law but there is no one to help adolescent boys. Some primary health care centers run teen clinic or adolescent health clinic (AHC) weekly on fixed days. Following are some findings based on understanding of ANMs/GNMs about adolescence:

  1. Around 70 per cent of the ANMs/GNMs were of the view that sexual desire and physical attraction are some of the important health concerns of both girls and boys during adolescence.
  2. Three-fifth of the ANMs/GNMs felt that during adolescence, both girls and boys, have an attention seeking behavior.
  3. More than half of the respondents were of the view that adolescents become self exploratory and evaluative.
  4. A majority of them suggested that to mainstream gender in reproductive and sexual health services, health and sex education should be provided to both adolescent boys and girls and their curiosities should be satisfied, then only they can lead a healthy life without any discrimination.

Based on further analysis a competency framework will be developed and tested out.

Socio-Cultural Dimensions of Sustainability of Sensitizing Self-Help Groups to Reproductive-health via Empowerment and Engagement (SSSTREE) - A Way Headed to End Frailty

Self-Help Groups (SHGs) are small voluntary associations of people from the same socio-economic background with a purpose of solving their common problems through self-help and mutual help. Usually self-help groups are women-oriented and most of their activities are concentrated towards savings and credit activities (apart from other activities focusing on women's empowerment, health and education attainment). Thus to make the SHG women members aware of their 'health rights', especially the reproductive right, Socio-Cultural Dimensions of Sustainability of Sensitizing Self-Help Groups to Reproductive-health via Empowerment and Engagement (SSSTREE) project was conceptualized. The study was undertaken by IIHMR, Bangalore and IIHMR, Jaipur with 10 SHGs in Chaksu block of Jaipur district in Rajasthan. The project aimed at familiarizing the SHG members with priority problems in health and RCH matters; to create awareness; and to sustain interest and memory through lesson plans in the prioritized problems. For this purpose some of the issues were identified, like, menstrual and personal hygiene, symptomatic recognition of RTI/STI, cervical cancer, HIV/AIDS were identified. FGDs were conducted with all the SHGs to understand the baseline status of the knowledge and attitude of the SHG members. Three day training on these issues was also conducted for 100 SHG members in two rounds. After the training, again End line FGDs were conducted with the SHGs to know the change in the attitude and knowledge of the SHG members.

During the training, participants were informed about the importance of hemoglobin level in the blood, which should be 12 or more and were taken to the CHC to check their Hb level. They came to know about it for the first time and promised to be very cautious about it for all their family and community members. During the training, an open session was held with doctor from CHC where all the participants clarified their misconceptions and problems so that they can be assured of their health status. The medical doctor also informed them about RTI/STI causes and consequences and also informed about the best ways to prevent these infections.

The training included audio visuals as well as charts and flexes so that the rural SHG members can understand the issues in their best ways. The participants came to know about the burning issue of cervical cancer. They were explained the causes, consequences, prevention and treatment of cervical cancer, which they felt was the most important information that they acquired from the training. The participants were also informed about the various schemes run by government for the betterment of people, which they were unaware of.

Change towards health and hygiene in the attitude of rural SHG members was observed. They have started washing hands with soap before doing household chores and also started practicing hygiene during menstruation. They now drink filtered water and have started eating green and leafy vegetables and fruits. They have become attentive towards cervical cancer and have decided not to bear child frequently. The SHG members have become aware of their health rights and do not hesitate in asking their husbands to go for a checkup if any sexual problem exists. These women have taken the initiative to educate women and adolescent girls of their village about health and hygiene in order to access their 'reproductive right'.


Pathfinder International has been working in Bihar on sexual and reproductive health. Their project - PRACHAR has worked to improve the health of the women and girls, and adolescents. They have involved adolescents, young women, men, their parents and influential members of the society as the target groups. The overall aim of this study was to develop an understanding of the gendered approach under PRACHAR project phase I and II. The specific objectives were to:

  1. review the PRACHAR reports to understand the gender multi-sectoral factors;
  2. explore multi-sectoral linkages to improve behavioral outcomes
  3. examine the processes that were implemented/ considered as strengths
  4. recommend improvement/ refinement of existing interventions that lack gender dimensions for youth.









Under this qualitative study, Focus Group Discussions (FGDs) were used to gather the information that was required and the sample included adolescent girls and boys who demonstrated positive behavior change and those who did not demonstrate any change in behaviour, parents (both mothers and fathers) of adolescents with positive and negative behavior changes, trainers in PRACHAR, community influencers and change agents (both men and women). The data collection tools included FGD guidelines for each category of respondents, observation sheet, and demographic profile. The proposal and the FGD guides were presented before to the Ethical Review Committee of IIHMR and suggestions of the committee were incorporated before its actual implementation. A total of 21 FGDs were conducted in July 2010 followed by their transcription and translation. Analysis was done by reviewing and extracting content from transcripts using the software package NVIVO Version 8.








The findings of the study revealed that participants were well informed regarding the benefits of further education as most of them mentioned educating their sons as well as daughters and equal importance was being given to both of them. Family size had reduced, as mentioned by our respondents most of whom preferred to have two children. Government's support has been substantial in providing incentives to those who are underprivileged. PRACHAR's contribution towards the change was perceived as significant and could not be neglected. There has certainly been an improvement but also a need for regular and follow-up training to aid in the desired behaviour change was felt. Government is providing support to the deprived but some sections of the society are still neglected and there is need to shift the focus on them. People are aware of the legal age for marriage but early marriage still takes place, dowry being the most commonly cited reason. It is interesting to note that dowry is associated with more educated as well as less educated girls. There is a need to enforce the laws and strict monitoring is required for this. Since guardians are predominantly the decision makers at home; even they should be trained and made aware of the sensitive issues. The study team recommended that:

  1. Inclusion of the deprived and the socially excluded as the target group
  2. Capacity building on gender issues and revision of the existing module accordingly
  3. Capacity building of parents (fathers and mothers) and teachers (men and women)
  4. Mobilising communities to eliminate the harmful practices such as early marriage and dowry
  5. Providing girls with viable alternatives to early marriage
  6. Enforcing existing laws on the age at marriage
  7. Considering gender based violence as a public health issue.


Birth Registration and the issuance of a birth certificate is the first legal acknowledgement of a child's existence by the State. Article 7 of the UN Conventions on the right of child states that "The child shall be registered immediately after birth and shall have the right from birth to a name (and) the right to acquire a nationality." Two decades after India became a signatory to the UN Convention on the Rights of Child, more than 9.3 million children every year are still denied their right to an identity. An unregistered child is in danger of being denied the right to an official identity, a recognized name and a nationality. With no document to prove how old they are - or even who they are - they are likely to join the millions facing discrimination and lack of access to basic services such as health and education. The current project will focus on the poor and vulnerable children especially the girl child of the deprived sections of society, to get identification through birth registration. Birth registration refers not only to registration but also to receiving the birth certificate. The children below 10 years of age will be covered for birth registration under the National Campaign. The project will also try to link issues of child rights violation with birth registration and certification. The previous experience has shown that less number of girls are registered and through this project will try to explore and address the reasons for the same.







IIHMR has been participating actively in conducting major health related surveys, RCH surveys, RCH survey for Rajasthan, Haryana and Punjab, adolescent health, gender gap in health staus, RTI/STIs in India and violence against Gender are some of the priority areas identified for research. Gradually more efforts are being made towards working in the direction of Gender empowerment and rights issues and this is reflected in the Institute's activities.

1.1 "Gender's Rights to Life Project" is initiated by the Columbia University (CU) and is being implemented by United Nations Children's Fund (UNICEF) and GoR to contribute to the realisation of Gender's rights to life and to the highest attainable standard of health. It aims to reduce maternal death and disability in a sustainable manner in three districts of Rajsthan: Jhalawar, Baran and Dholpur. A needs assessment study was conducted by IIHMR in three districts. It has been observed that EmOC services were poor in the districts. Then the institute, as a Technical Support Unit operationalised the project in the districts. Through the project important infrastructural inputs are made to ensure adequate EmOC services at the district hospital level. At the same time organisational transformation is sought through the use of appreciative inquiry methodology. Appreciative Inquiry worksops and its documentation is done with technical support of IIHMR.

1.2 A 17-month study was conducted by the Institute on " Men's Perspective on Domestic Violence Against Gender" supported by ICRW with the following objectives:

  1. Understand violence in the domestic sphere
  2. Examine the link between violence and masculinity
  3. Study the process of social construct, with special reference to socio- culturalcontext, in male identity formation vis-à-vis sexuality
  4. ascertain the community's response to violence in the domestic sphere
  5. assess awareness level of men about legal issues in violence against Gender

1.3 Aapni Yojna

An Integrated Water supply, Sanitation and Health Programme is implemented in three districts of Rajasthan: Hanumangarh, Churu and Jhunjhunu to improve the health status and living conditions of the target population. The Community Participation Unit (CPU) has been formed by consortium of five leading NGOs with IIHMR as a nodal agency. Gender's participation in the project is a cross-sectoral component and considerably increasing. Gender's-, Self-Help -, User-and other groups serve as the platforms for Gender's decision-making and are now multiplying in all regions where CPU is actively involved. Female stakeholders take up responsibilities related to water, sanitation and health at Water and Health Committees (WHCs), Pani Panchayats, User groups, etc., at the Mohalls and village level.

1.4 ASHA Motivation Audit in Uttar Pradesh

Documentation and Dissemination

The perspectives and experiences of Gender on health issues, successful Gender's health interventions and gender sensitive programme strategies are the focus of documentation efforts.

2.1 Case Study The case study of Child in Need Institute (CINI), West Bengal, namely "RCH Initiatives of Child in Need Institute, 24 Paraganas (S), West Benagal" was developed under the project. For this activity, an exploratory trip was made to the organisations. Experiences of moving from a maternal and child health programme to a comprehensive rural health programme were recorded. This is an ongoing activity. Hindi adaptation of this case study and other published case studies is in process. The case studies, developed under the project, are shared with the partner organizations. The studies are also used for teaching in various academic programmes.

2.2 Pragya series: partnership in Gender's empowerment It is an effort to calibrate the performance of our partner NGOs who are venturing into health sector. The Pragya series is published to disseminate the information on the strategies adopted by the partner NGOs to implement various projects for the well-being of the community particularly Gender and children.

2.3 Other documents developed under the resource centre are: Set of references: The centre has compiled set of references on "Gender and HIV/AIDS", "Mental Health among Indian Gender". "Gender and RCH Module" is compiled as an aid for the grassroots level health workers. It focuses on development stages of a child to an adult man/ woman. It also describes the biological and social differences of a man and woman and gender empowerment. The module is pictorial and can be used by grassroots level workers, with low educational qualification.

A three-day gender training module is developed for the Post Graduate Diploma in Health and Hospital Management (PGDHM) course focusing on gender and health issues.

A one-day gender training module for training of NGO health professionals and other programme managers is also developed. It is being used extensively for mainstreaming gender in the ongoing Management Development Programmes of the Institute. "Towards Empowering Gender" is a compilation of various capacity building activities conducted under the project "Resource and Training Centre on Gender's Health, Empowerment and Rights" supported by the Ford Foundation.

2.4 A dissemination-cum-experience workshop was organized with the development practitioners (on reporductive health in gender perspectives) of Jaipur on August 11, 2000 at IIHMR. The objectives of the workshop were:

Learning from the participants' experiences on Gender empowerment, rights and health Sharing the activities of the Ford Foundation supported Resource and Training Centre on Gender's Health, Empowerment and Rights Project. Identifying areas of further collaboration with the participants

Management Development Programmes

Training of Trainers on Adolescents Reproductive and Sexual Health under SABLA

Objectives of the scheme are to:-

  1. enable self development and empowerment of Adolescent Girls
  2. improve their nutrition and health status;
  3. spread awareness among them about health, hygiene, nutrition, Adolescent Reproductive and Sexual Health (ARSH), and family and child care;
  4. upgrade their home based skills, life skills and vocational skills;
  5. mainstream out of school AGs into formal/non formal education;
  6. inform and guide them about existing public services, such as PHC, CHC, Post Office, Bank, Police Station, etc.

Download SABLA2012 report

Capacity Building Workshop of Programme Officers and CDPOs on SABLA

The objectives of the training were to:

  1. Clarify various components of the scheme for reaching out to school going and non school going adolescent girls.
  2. Improve knowledge of nutrition, sexual and reproductive health and rights
  3. Link those above 16 years of age with vocational skills opportunities.
  4. Strengthen POs and CDPOs to train Supervisors and Pracheta for the scheme and further to train Anaganwadi workers and Saathin for better implementation of the programme at the district and field level.

Download SABLA2014 report

Gender - responsive budgeting

Gender - responsive budgeting helps to track the way the budgets respond to women's priorities and the way governments use funds to reduce poverty, promote gender equality and lower the rates of maternal and child mortality. There is a need to create skills to effectively engage in mainstreaming gender in planning and budgeting processes at country, state and local levels. The Institute organized a gender-responsive budgeting training program in collaboration with the Gender Cell of the Directorate of Women Empowerment and UNFPA, Rajasthan during October 25 - 29, 2010 with the following objectives

  1. To have an overview of the development of gender-responsive budgeting in India, basic gender concepts, the purpose and the core concepts related to gender-responsive budgeting.
  2. To understand that an active role in gender-responsive budgeting will contribute to a larger initiative that is in line with Government of India's national and international commitments
  3. To understand that the nature of gender-responsive budgeting differs between countries due to a range of factors.
  4. To develop the appropriate strategy for successful gender budgeting at their respective level.
  5. To understand a non-academic method of gender analysis and the different entry point tools preferred by the Ministry of Women and Child Development (MWCD) and how they relate to the five steps of gender budgeting.
  6. To gain a practical experience of appraising proposals for new social services and infrastructure projects.
  7. To understand the data needs associated with gender budgeting.
  8. To develop recommendations on the basis of gender-aware impact analysis and evaluation.

The Program broadly covered the areas of gender concepts and gender budgeting in India, What is gender budgeting, gender budgeting processes - planning and policy transformation, gender budgeting analysis tools - Diane Elton's tools, costing tools - MGD costing methodologies, gender budget statements, country case studies, entry point tools for gender budgeting, gender appraisal of new programs, designing indicators for gender budgeting, impact analysis and lastly, outcome budget - group work and presentation. The Participants for the workshop included mainly the nodal officers from 10 departments of the State Government (like Department of Agriculture, Finance, PRI, etc.) and from NGOs. The program was divided into small sessions which were facilitated by Ms. Benita Sharma, Dr. Paramita Mazumder and Dr. Swapna Bist Joshi from Delhi. They are consultants with rich experience in gender-responsive budgeting. The resource persons included the Institute's faculty and research officers.

Policy Formulation and Advocacy Efforts

The Institute has been particpating actively in the formulation of State Population Policy and State Policy on Gender. 1.Two-day state level workshop was organised jointly with the Rajasthan State Gender Commission (January 15-16, 2001) with support of UNICEF, Rajasthan. The workshop presupposed that Gender have the capability to reproduce and the freedom to decide why, when and how often. This would initiate the process of empowerment of Gender. The objective of the workshop was to develop operational strategies for the implementation of the State Gender Policies and the Population Policy with the ultimate goal of improving the reproductive health of Gender in the state. 2.A workshop was organized by the Institute in collaboration with UNICEF and Rajasthan Gender's Commission Regional Consultation on "Girl Child and the Tenth Five Year Plan" (November 27-28, 2001). The consultation was a part of the Joint UN Inter agency Working Group on Gender and Development's (UNIAWG-G&D) commitment to promoting gender equality, particularly, within the context of formulation of the tenth five-year plan. The tenth five year plan is being formulated against a backdrop of some disturbing trends like the juvenile sex ratio (0-6 years) dipping to its lowest in fifty years in all but four states, which gives a clear evidence of the toll on girls and Gender's lives. The regional consultation was initiated taking cognisance of this fact and to support and complement the efforts of the Planning Commission in developing gender sensitive policies to recognize female human capabilities and their potential for ushering in development. The idea was to bring a new dimension to the planning process in India, to advocate and mainstream gender concerns, a core requisite for sustained development across all sectors

Technical Support to Gender's Health Programmes

The Institute has a multi-disciplinary faculty and consultants with wide ranging experience in research and training. It also has the technical know-how to provide support to Gender's health programmes and has been working with international and government agencies. Area Networking and Development Initiatives (ANANDI), Devgarh Baria, a Gujarat based partner organisation, has requested the Institute to conduct two training workshops for their field workers. The resources provided were the expertise by way of resource persons and training material. A gender sensitisation workshop for 11 Gujarat based NGOs working in Saurashtra and Panchmahal region was also conducted.

Networking and observing/ celebrating important national/ international days


Supported by: Project Management Unit (PMU), Global Alliance for Improved Nutrition (GAIN)

Organized by: Gender Health Resource Center (GHRC) at IIHMR

Every Year, 28th May is observed as the International Day of Action on Women's Health throughout the world. It is a day to call for action towards the improvisation of women's health / protecting the sexual and reproductive health of women. Although progress is reflected in many of the areas but there are still major areas of concern as far as women and children are concerned.

One-day workshop was organized by Gender Health Resource Center (GHRC) at IIHMR, Jaipur on May 28, 2013 to observe the International Day of Action on Women's Health focusing on the 'Health and Nutrition: Empowerment of Self Help Group Members'. A total of 70 participants attended the workshop, including women SHG members who came from both rural and urban areas of Jaipur. The workshop was organized with an objective to empower SHG women members by providing information on micronutrient malnutrition and availability of fortified wheat flour, oil, milk and soya dal analogue through both theopen market and government distribution channels .

The workshop was started by asking the women to pick a vegetable or pack of cereals from the basket to introduce self by relating with the picked item. After the 'fun-filled introduction', which also worked as an ice-breaking activity, the participants sang a chetna geet (inspirational song), which worked as an energy source to enlighten their strengths. Importance and objectives of the day were shared with the participants.

Dr. Deepti Gulati, Senior Associate, GAIN introduced the project. The GAIN project aims at reducing the prevalence of micronutrient deficiencies by making available fortified wheat flour, oil, and milk which are used on daily basis irrespective of rich and poor. A Project Management Unit (PMU) at IIHMR has now launched fortified wheat flour, oil and milk through open market channels and government distribution channels. She explained the participants the process of fortification and also described the need to fortify the food. She said that as nowadays even fruits and green vegetables have become costly, poor people are unable to afford these, which results in malnourishment as proper nutrients required by the body are not supplied to it. Thus, to make these nutrients available to all, GAIN has started a project to fortify some of the food products. By the process of fortification required vitamins and minerals are added to the product, which makes it rich in nutrients, which may help in reducing malnourishment. She also added that although fortified food will help in reducing malnourishment, but it is also important to eat green vegetables and fruits in a very interesting and simple way (saying colorful plate with the colorful things like white, yellow, green, and orange)


Dr. M.L. Jain, ex Director (RCH), Govt of Rajasthan explained the importance of nutrition for a woman. He said that as oil, milk, wheat flour are the most common food items consumed by a household, it can be easy to reduce or even remove malnutrition if these products are fortified. He also informed that government supplies fortified wheat flour at the ration shops. The products are fortified at no extra cost.

To demonstrate, the participants were then served with nutrient added biscuits and milkshake made from fortified milk. Dr. Jatinder Bir Singh, Project Manager, PMU-GAIN shared the posters, pamphlets, jingle and videos which are being used in the promotion of fortified products by PMU. He also shared the process of fortification and the technicalities involved with it. The samples of fortified oil and milk were shown to the participants and were asked to remember the stamp of fortification which every fortified product contains.

After fortified lunch, again chetna geet was sung to revive the strengths. Dr. Santosh Gandhi, Gynecologist, held an open session with the participants, where they discussed their health problems with her. She helped the participants to establish anemia with the need of spacing between births. She discussed the available methods of contraception at AWCs, with ASHAs, ANMs. She also discussed about emergency contraceptives pill (ECP), which was recently launched by the government, was a new concept for the few. Dr. Rajeshwari Gupta, Gynecologist, explained the participants about IUCD. A sample of IUCD was also shown to the participants. She informed them about the new available IUCD, which can be used for 10 years. She also clarified the myths associated with IUCD insertion, which helped a lot to the participants in building their confidence towards its use.

At last, a group activity was performed, where the participants from different areas were divided in groups of five and were asked to discuss the knowledge and information gained in the workshop. They were also asked to write the group's and individual's accountability on carrying the information gained in the workshop to further in the community. The workshop was then wrapped up with a vote of thanks to the participants, resource persons, and BCT, GSS, SRKPS representatives who gave their time in making the workshop a success.


Partner Organisation 1: Deepak Charitable Trust (DCT), Baroda, Gujarat

Ms. Aruna Lakhani,Chief Co-ordinator/ Honorary Secretary Shri Ashok Makwana, Programme Officer Website: Deepak Charitable Trust is involved in improving the quality of life of people living in Nandesari area. The past five years have witnessed the growth of DCT towards a definite and a clear direction leading to integrated community development. The growth has been all round, both in quantity and quality of its professional staff and the intervention programmes. Now, DCT has carved a niche for itself in implementing innovative intervention strategies and has proved that it is possible to build capacities of relatively non-literate community, particularly Gender. A deep and clear understanding of the community has led to devising strategies which work and have naturally discarded models which don't work within the cultural and social realities of the area

Partner Organisation 2: Society for Conscientisation Awareness and Training

(ECAT Bodhgram, Kukanwali, Kuchaman City, Dist. Nagaur), Rajasthan Ms. Kamla Chaturvedi Mr. Ram Swaroop Raika Mr. Dileep Yadav Website: The organisation has been active in Kutchman block since 1988 and has its own campus (Bodhgram). Initially it started work as a Technology Mission Project on drinking water but slowly graduated to meet community's other felt needs like health, nutrition, sanitation, education, and Gender's development. ECAT aims at sustainable development of the community through: Understanding marginalisation and subordination Empowerment, especially of Gender Promoting people's collective/organisation to raise the quality of their life Implementing multidimensional action programmes through people's participation To consolidate the efforts of the organisation in the area of Gender's development, it undertook the responsibility of setting up the district IDARA unit in Nagaur in 1997.

Partner Organisation 3: Bhoruka Charitable Trust (BCT), Bhorugram, Churu, Rajasthan

Mr.Amitabh Banerjee Project Director Mr. Balwan Singh Ms. Yashwanti Punia Bhoruka Charitable Trust (BCT) was founded in 1964 by late Shri Prabhu Dayal Agarwal, a philanthropist and the Founder Chairman of TCI-Bhoruka Group of Companies, as a response to the gross poverty that he saw in Rajgarh, Rajasthan. It is involved in working for rural development in 300 villages of district Churu, Rajasthan. The Trust is involved in running non-formal schools for girls in 150 villages, ICDS centre in 200 villages, and other development activities. BCT believed that the transformation in the villages would be more effective if it began at home. BCT is dedicated to socio-economic transformation of rural and remote areas of India, especially the weaker and socially underprivileged groups, through physical, social, cultural and economic development of rural people, groups and institutions.

Partner Organisation: DHARA Sansthan (Society for Develoment Health Hygiene and Rural Action), Barmer, Rajasthan

Shri Mahesh Panpalia An organisation, namely Manav Sewa Samiti was established in 1989 in Barmer, which mainly worked as a Charitable Dispensary till 1997. In 1998, the name was changed DHARA Sansthan -a Society for Develoment Health Hygiene and Rural Action. Its main objective is to create awareness of various development issues (education, health, empowerment, and overall quality of life) with a participatory and decentralised approach.


August 27, 2016 Seminar on Child rights and Women empowerment: Role of Development Managers

September 3, 2016 Seminar on Human Trafficking